Dysphagia megalatriensis

Dysphagia megalatriensis, also known as cardiovascular dysphagia or cardiac dysphagia, is an impairment of swallowing due to oesophageal compression from a dilated left atrium. 

Presentation is generally with mild dysphagia, although a minority of patients will have dysphagia severe enough to develop weight loss and nutritional imbalances 1-5. The most serious complication is development of an atrio-oesophageal fistula resulting in fatal haematemesis 2.  

Dysphagia may or may not be present with other symptoms and syndromes of left atrial enlargement such as haemoptysis or Ortner syndrome 4.

Oesophageal compression and resultant dysphagia secondary to left atrial enlargement is considered to be very uncommon 1,3,5. This is likely because when the left atrium enlarges posteriorly, the oesophagus is usually able to 'slip' to either side of the vertebral body and thus, avoid being compressed until the left atrium is very large 3

Similar syndromes are seen secondary to other vascular anomalies, such as an aberrant right subclavian artery (dysphagia lusoria) or an aneurysmal or tortuous aorta (dysphagia aortica) 5-7.

Due to the rarity of this condition, it is important to exclude other commoner causes of dysphagia before settling on this diagnosis 5.

Chest radiographs demonstrate features consistent with left atrial enlargement 1-5.

Barium swallow or oesophagography of the oesophagus reveals delayed transit and demonstrates an indentation in the oesophageal wall by the dilated left atrium 1-4

These cross-sectional modalities will allow the best visualisation of a dilated left atrium compressing the oesophagus 4,5.

Treatment is necessary only if symptomatic, and generally patients will require a nasogastic tube for enteric feeding 1,4. Management of the underlying cause of left atrial enlargement (e.g. mitral stenosis) is also pertinent. 

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Article information

rID: 54406
Tag: cases
Synonyms or Alternate Spellings:
  • Cardiovascular dysphagia
  • Cardiac dysphagia

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